Succession inside a growth and digital function

A growth and digital function inside a hospital group is usually built around one person. That person fought for the budget, hired the first team, chose the CRM, negotiated with the aggregators, learnt how to talk to medical directors, and sits in the P&L review because the CFO trusts them personally. When they leave, the function does not so much decline as evaporate. The vendors drift. The contact centre reverts to the old scripts. The dashboards stop being read. Within two quarters the group is back to running on doctor reputation and walk-ins, and the board wonders what the digital budget was ever for.

I have watched this happen to peers, and I have been the person around whom a function was built. It is flattering for exactly as long as it takes to realise that a function that cannot survive you is not a function. It is a project with your name on it, and the group will treat it that way when the next reorganisation comes.

Succession in this seat is not a human resources exercise. It is the difference between having built an engine and having been one.

The roles that are hardest to fill

Most groups can hire a performance marketer, a designer, a social media lead. The market is full of them and the healthcare-specific learning is a few months. The roles that take years to fill, and that a function collapses without, are narrower.

• The product manager who understands a hospital. Someone who can write a patient booking journey and also knows why a department will not release its slots, what a TPA pre-authorisation does to a patient’s timeline, and why the doctor’s availability in the system is not the doctor’s actual availability. This person is rare because product management as a discipline barely exists inside Indian hospitals, and product managers from consumer companies find the hospital’s constraints unreasonable until they have lived with them for a year.
• The data lead who can reconcile a patient. Not a data scientist. Someone who can take the hospital information system, the CRM, the app and three unit-level spreadsheets and produce a defensible answer to “how many new patients did we get last quarter and what were they worth”. This is unglamorous, politically fraught and the foundation of every number the function reports. Nobody grows up wanting to do it.
• The contact centre and CRM operator. The person who runs the layer between demand and the hospital: scripts, languages, callback discipline, the handover into the unit. It is an operations job in a marketing function, and marketing people do not want it, and operations people do not want to work for marketing.
• The commercial translator. Someone who can take what the funnel says and turn it into a sentence the CFO and the medical director both accept. This is the role I did not know I was filling until I tried to delegate it and found nobody could.

The common thread: every one of these is a hybrid, and hybrids are not produced by any job market. They are produced by putting a capable person in a room with a problem for long enough.

Why the usual succession answer does not work here

The standard playbook says identify two successors for every critical role, put them on a development plan, and review annually. It works in functions where the roles are stable and the skills are teachable in a classroom. It does not work here for two reasons.

The roles are not stable. The function’s shape changes every eighteen months as the group’s strategy changes — a launch year needs a demand-generation lead, a consolidation year needs a data lead, a platform year needs product. A successor groomed for last year’s role is groomed for a job that may not exist.

And the skills are not classroom skills. The product manager learns what a hospital is by sitting in the unit’s morning meeting for six months. The data lead learns the reconciliation by doing it wrong twice. The commercial translator learns by being in the P&L review when a number is challenged and having to answer. None of this can be scheduled.

What works instead is exposure. Not a plan, a practice of putting the people you are growing in front of the situations that made you, before they are ready, and letting them be uncomfortable in a way that does not cost the group.

Growing product and data talent inside a hospital

The instinct is to hire this talent from technology companies. I will come to when that is right. But the more durable route, and the one I underestimated for years, is to grow it from people already inside the group who have the temperament and lack the vocabulary.

The best product person I have worked with in healthcare came from the contact centre. She had spent three years listening to patients fail to book appointments. She knew every reason a journey broke, in four languages, and she was angry about it. What she lacked was the discipline of writing a specification, prioritising a backlog and saying no to a department head. That took a year of pairing with an external product lead and a great deal of protection from me. It was worth more than any hire from a consumer app.

The same pattern holds for data. The people in a hospital who understand the data are the ones who have been fighting it — the billing team, the medical records team, the unit’s MIS person who produces the monthly numbers by hand. They know where the identifiers break and why. Give one of them a modern toolset, a mandate, and a seat in the growth function, and you get a data lead who can reconcile a patient. Hire a data scientist from outside, and you get someone who builds a model on data they do not know is wrong.

The trade-off is speed. Growing takes eighteen months to two years. Hiring takes a quarter. If the group is in a launch year, you may not have the time, and you should say so rather than pretend.

When to hire from outside healthcare

Three situations, in my experience, and they are narrower than most hiring plans assume.

When the function needs a discipline that does not exist inside it at all. If nobody in the group has ever run a product backlog, a search programme at scale, or an experimentation practice, you cannot grow it. Hire the discipline, and pair the hire with someone who knows the hospital, from day one. The failure mode is the reverse — hiring the outsider and expecting them to learn the hospital alone. They will leave inside a year, and the group will conclude that consumer talent does not work in healthcare, which is the wrong lesson.

When you need a different standard of what good looks like. A function that has only ever seen hospital digital work does not know what a well-run booking journey or a properly instrumented app looks like. One person who has seen it — and who has the patience not to say so in every meeting — raises the bar for everyone.

When you are hiring for a role that will replace you. I will come to that.

The situation where outside hiring reliably fails is the one where it is most tempting: the group has a digital strategy on paper, no team, and a board that wants a name. Hiring a senior consumer-tech leader into that seat without an internal counterpart, a P&L relationship, or a medical director who has agreed to work with them is a two-year experiment that ends the same way every time.

Making yourself replaceable on purpose

This is the part that operators resist, and the part I resisted longest. Everything about the seat rewards being indispensable. The CFO calls you. The unit heads call you. The vendors call you. You are the node through which the function’s knowledge, relationships and judgement flow, and it feels like influence. It is actually fragility, and the board knows it even when you do not.

What I did, roughly in order, and later than I should have.

I wrote down the decisions. Not the strategy — the decisions. Why we chose this CRM, why we stopped spending on that channel, why we do not count corporate patients as growth’s, why the contact centre answers in the caller’s language even when it costs more. A function’s judgement lives in these, and when the person who made them leaves, the function forgets them and re-litigates them all.

I moved the relationships. I stopped being the only person in the P&L review. My data lead presented the numbers. My product lead took the unit heads’ complaints. My contact centre lead sat with the medical director on the callback process. The first few times were rough. The CFO wanted to talk to me. I sat in the room and did not answer. Within two quarters the relationships were theirs, and they were stronger than mine had been, because they were closer to the work.

I hired above me in one area. The product lead I brought in had run product at a scale I never had. There was an obvious risk that she would be seen as my replacement. She was, and I told the group that was the intention. It changed how the board saw the function — not one person’s project, but a bench.

I made the numbers not mine. The three numbers the board sees are produced by a process, documented, owned by the data lead, and I could not alter them if I wanted to. When a number is a person’s, it leaves with the person.

What the group has to do

None of this works if the group treats the function as one executive’s remit. The executive committee has to decide that growth and digital is a permanent capability, with a budget that survives its leader, roles that are graded and paid like the hospital’s other senior roles, and a reporting line that does not change every time a chief executive does.

The specific thing to ask for: that the function’s second layer — product, data, contact centre, commercial — be treated as group talent, reviewed by the executive committee and not only by you. It costs you some control. It buys the function a future.

If you are starting this next quarter

1. List the four hybrid roles and write against each one the name of the person who would do it if you were hit by a bus. If any line is blank, that is your first hire or your first development bet.
2. Write down the twenty decisions the function runs on and why. Circulate it to your second layer and let them argue.
3. Pick one person inside the hospital who understands patients or data and lacks the vocabulary. Move them into the function. Pair them with the strongest external person you have. Give it eighteen months.
4. Take yourself out of one recurring meeting every quarter and put a team member in it. Do not brief them afterwards on what they should have said.
5. Ask the executive committee to review your second layer directly. Once a year is enough.
6. Have the conversation about who replaces you with your own chief executive before they have it without you.

The measure of the seat is not what happens while you are in it. It is what is still running a year after you leave.